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Symptoms

Robert is a twin, who  was delivered at 36 weeks and was intubated at birth for two days due to immature lung development. He was in the neonatal intensive care unit for two days and received phototherapy for jaundice. Robert failed the newborn hearing test twice in his left ear.

He received Early Intervention services until three years of age for speech and language delays. He is now enrolled in an integrated preschool program where he is receiving occupational, speech and physical therapy.  Robert also is receiving private speech therapy two times per week.

Robert was referred to Project CHILLD due to concerns regarding speech delays, motor incoordination, sensory processing difficulties and decreased social participation at home and in school.

Clinical observations at the time of Robert’s initial assessment concluded that Robert presented with moderate difficulty in the areas of postural control, motor planning, bilateral coordination and fine motor skills, and presented with gravitational insecurities. Robert was unable to jump with a two-foot take off, lift his head or upper extremities against gravity from a prone position, or assume supine flexion.  Robert had moderate difficulties with ideation, and initiation. He was unable to form prewriting shapes, or use functional grasp on scissors or writing tools.

Also at the time of his initial assessment, Robert’s parents reported that Robert had not been successful with toilet training, required moderate assistance for dressing and oral hygiene, and had difficulty socializing with peers.

Intervention:

  • Robert completed 31 clinic-based iLs sessions, each 90 minutes in length.  Robert attended three to four listening sessions per week with a three to four week integration break after the 15th session and then again after the 23rd session.
  • Each of the 31 sessions included a strong oral motor component.
  • Each session included movement-based activities.

Summary of chronological changes reported by home and school:

December

  • Robert’s mother reports that Robert is independently looking at books and naming items, saying, “It is as if he is reading to himself”
  • Increased eye contact, and increased energy are reported

January

  • Robert’s speech therapist reports that Robert is starting to approximate words with vowel sounds and consonant transition: “No ta-ta” for “no tiger,” and making approximations with closing sounds: “hap” for “help”

February

  • Robert begins to use new sounds during play such as “choo-choo” when playing with trains, and siren sounds when playing with fire trucks
  • Robert demonstrates an increase in his number of sounds and signs in combination
  • Robert begins to join in when others are humming or singing
  • Mom also reports that Robert is responding to questions more quickly and joining in family conversations
  • Robert makes progress dressing himself and begins initiating the dressing process in the morning

March

  • Robert’s speech therapist reports, “Robert’s articulation skills are taking off”
  • He is singing along with songs at school and home
  • Robert is using consistently blended consonants and vowels
  • Robert counts to 10
  • Demonstrates more vocal control, using “no” instead of “na na na”
  • Shows an increased ability to modulate the volume of his voice
  • Robert dresses and washes himself; he is completely potty trained

April

  • Robert begins approximating short sentence structures. “I hear a______________, I see a _______________.”
  • Robert is labeling letters

May

  • Robert begins communicating verbally at circle time; he can name all of his classmates
  • He is able to answer “wh” questions
  • His language becomes natural and spontaneous

June

  • Robert begins consistently speaking in short structured sentences, asking questions and offering information independently

The Results:
Robert showed dramatic improvement is the area of speech and language.  His private SLP has rewritten his goals three times since May because he is progressing so quickly. He is no longer using any assistive device for communication.

Dramatic changes in other goal areas have also been noted.  Robert demonstrates improvement is vestibular processing.  He currently seeks out a variety of types of suspended equipment in the clinic, and demonstrates improved balance. He is able to jump with a two-footed take off, and his ability to balance on one foot is emerging. Robert demonstrates improved strength and endurance; he is able to hold his upper body against gravity in prone.

Robert’s mother states the following changes in endurance, “Prior to iLs, Robert would tire after sitting up for twenty minutes while engaging in an activity. He would often continue playing while lying down on the floor. He was difficult to rouse out of bed in the morning. Since the first phase of listening iLs, Robert wakes spontaneously in the morning and maintains an aroused energy level throughout the day”.

Robert now is able to demonstrate reciprocal crawling.  He has improved in ideation, as he can plan a 3-step obstacle course, and now approaches his therapy sessions with specific ideas and plans for activities. He is able to engage in turn-taking activities with peers; however, he still is not initiating play. He is dressing himself, washing himself in the tub and is completely potty trained.

Beginning approximately six weeks after the end of iLs, Robert had a ‘language explosion.’ The gradual progress he has been showing suddenly grew exponentially every day. Now three months later, he talks constantly, saying almost anything he wants to say and speaking in full sentences (with developing articulation).  For a long time, Robert’s thoughts were trapped inside of him. Now they flow from mouth. He is still difficult to understand, but with speech therapy, he is improving every day. – Robert’s parents

Learn how iLs influences speech by enhancing sensory input while continuing to address targeted speech-language and voicing goals, enhance auditory and language processing skills, and address the organizational components of speech and language.

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